Do I Need My Testicles Removed If I Have Testicular Cancer?

Testicular cancer, affecting the testosterone and sperm-producing sex glands, the testicles, distresses not more than 1 percent of all men who are diagnosed with different types of cancer. But cancer of the testes is increasingly common between the ages of 15 to 34, particularly in the white Caucasian population in the economically advanced societies of the US, UK, and Northern Europe. The positive news is that the cure rate is very high regardless of whether testicular cancer is detected early or at an advanced stage.

Usually, doctors treating testicular cancer recommend the surgical removal of one or both testicles through an operation called an orchiectomy. It is a life-altering decision considering the physical, mental, emotional, hormonal, and lifestyle transformation it brings about in a man’s life. But timely detection of testicular cancer does not always necessitate immediate testicle removal, and the doctor may adopt a wait-and-watch policy to assess how the cancer is progressing before deciding on surgery and related treatments.

Situations Demanding Orchiectomy As the Primary Form of Medical Intervention

• Testicular Cancer

Germ cells that are early prototypes of sperm and the Leydig cells that produce male sex hormones sometimes behave abnormally and multiply rapidly to form cancerous tissue within the testes. The tumor makes the testes swell, destroys normal tissue, and disrupts healthy functioning of the male sex organs. Removal of the affected testicle is done in the larger interests of the patient to avoid the disastrous consequences of having the cancer spread and wreak havoc in sensitive locations in the body.

• Testicular Torsion

With the passage of time, the supportive tissue surrounding the testes may weaken, and the stiff spermatic cord supplying blood to the testes loosens and twists around itself. This mostly affects adolescent males, producing waves of sharp pain, disrupting blood supply, and damaging testicular function. In some instances, the manual correction does not work, and the pain recurs, the condition worsens, and the testes wither away due to lack of blood supply. The damaged testicle has to be removed surgically.

• Testicular Trauma

Because of their peculiar position outside the body cavity, the testes remain unprotected and susceptible to injury caused either by physical movement or trauma resulting from kicking or pointed jabs. Athletes are more prone to suffering trauma that may be severe enough to remove the damaged testicle.

• Testicular Abnormality - Cryptorchidism

Many adults suffer the peculiar problem of undescended testes. During fetal growth, the testicles remain within the abdominal cavity and descend into the scrotum shortly before birth. When this does not happen, we have either one or two undescended testes. Because the sperm in the undescended testicle do not grow efficiently at higher body temperatures, affected individuals may become infertile and incapable of fathering children. The condition can be surgically corrected through an orchiopexy, but damaged testicles may need to be removed.

Testicular Cancer Is the Most Common Cause of Surgical Removal of Testes

Testicular cancer mostly affects men at the peak of their reproductive age (15 to 34).  Doctors will be anxious to preserve normal sexual function and performance and will recommend testicle removal only to prevent the spread of cancer. The decision of whether or not to remove the testes will be guided by the kind of cancer that the surgeon is dealing with, and the particular stage at which cancer is growing.

Cancer Type and Stage of Development Influences Testes Removal

Carcinoma In Situ

In this type of cancer, the germ cell behaves abnormally but the malignancy is confined to the sperm-producing seminiferous tubules and does not invade other tissues. Because it rarely produces any external symptoms, carcinoma in situ remains undetected till infertility issues drive the patient to the doctor who discovers the problem following a testicular biopsy.  In such a situation, the doctor may postpone surgery and adopt a wait-and-watch policy along with periodical physical checkups, tumor marker tests, and ultrasound scans.

The Stage I Seminoma Cancer

This is a slow growing germ cell testicular cancer that is 100 percent curable. As long as the cancer is confined to a single testicle and has not spread to the lymph nodes, doctors would prefer to be watchfully vigilant. Instead of removing the testes, the patient could be placed under medical supervision for many years. The patient may undergo low-dose chemotherapy and radiation targeting the germ cells, alongside half-yearly blood tumor market tests, ultrasound screening and CT scans to ensure that cancer has not spread through the lymphatic channels. Radiation treatment would involve 10 to 15 short duration sessions covering a three-week period.

The Stage I NonSeminoma Cancer

These cancer cells multiply and spread faster and require a more aggressive treatment schedule beginning with the surgical removal of one or both affected testes. Thereafter, treatment options will be largely influenced by the stage of growth of the tumor cells. Chemo and radiation therapy will be repeated every two months. Diagnostic imaging tests will be repeated every four to six months to respond appropriately to tumor growth.

Advanced Stage Testicular Seminoma and Non-Seminoma Cancers

In advanced stage testicular cancer, tumor cells spread via the lymphatic system and the circulatory system to distant parts to settle in sensitive organs like the lungs and the liver. In addition to orchiectomy (testes removal), the following procedures may also be urgently required.

• Retroperitoneal Lymph Node Dissection (RPLND)

Major lymph nodes at the back of the abdomen position themselves around the larger blood vessels called the aorta and inferior vena cava. If tumor cells invade the lymphatic ducts, surgeons will consider removing the abdominal lymph nodes to prevent cancer from spreading outwards. This procedure may be combined with the testes removal operation. Aiming for a higher success rate, the surgeon may recommend short duration chemotherapy and radiation cycles at these nodal sites following RPLND.

The Side Effects of Testicular Removal, Radiation, and Chemotherapy

Short-Term Effects of Surgery, Radiation, and Chemotherapy

• Respiratory issues following anesthesia.
• Uncontrolled bleeding in surgical wounds and delay in healing.
• Blood clots that go on to create aneurysms and embolisms in blood vessels, particularly in the lungs, heart, and brain.
• Pain, and localized infection, and inflammation of tissues.

Long-Term Effects of Orchiectomy

• Infertility or inability to father children if both testicles are removed.
• Shortage of testosterone leads to loss of erectile function, and declining libido and sex drive.
• Hot flashes and general rise in body temperature.
• Diminishing muscle strength and a general sense of tiredness (loss of energy) and fatigue (inability to mentally and physically cope).
• Image issues caused by changed external appearance and anxiety regarding how partners will react.

Testosterone deficiency can be remedied through long-term hormone replacement therapy, and an artificial testicular prosthesis can shore up cosmetic appearances down under.

Side Effects of Retroperitoneal Lymph Node Dissection

• Obstruction of bowel function followed by urinary and fecal incontinence (voluntary voiding of urine and stools).
• Nerve damage that may cause delay or difficulty in ejaculating. In retrograde ejaculation, the semen enters the urinary bladder instead of exiting the urethra.

The Last Word

To the question “Do you need your testicles removed if you have testicular cancer?”, the appropriate answer would be, “not necessarily.” Doctors are generally in agreement that testicles should be preserved if the threat of cancer remains dormant or cancer is moderately active but not life-threatening. The only rider is that you need to undergo periodical checkups to make sure that the cancer has not moved out of the testes. In cases invasive carcinomas that spread faster and cause more damage, surgical removal of testicles cannot be avoided.